2004, 05-03 Permit App: BLD-04-04246 Reroof*lane
Valley
E3UILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
fl 1, 11707 E. Sprague Avenue, Suite 106
"� _ Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: (20 2 S. E. Yetyr 7) MC
Assessor's Tax Parcel Number(s):
Legal Description:
i5
PERMIT DESCRIPTION: ra - r-r,Q`i
M Building Permit
❑ Relocation
❑ Change in Use Grading ❑ Manufactured Home
Fl Tenant Improvement ❑ Fire Safety
❑ Other
OWNER/APPLICANT INFORMATION
Owner: ry04t a Er (EBs1 eedlx>rct, Applicant: Lpg,xr cc, Qw'Q-
Fax:
Phone: YYB-23/9 Fax: Phone:
Address: /Tc a J' E "crgrezr> 12g Address:
1/efa<La(e, WA ✓ 99oj7
City State Zip Code City
❑ Contractor:
Phone: Fax:
Address:
City
State Zip Code
WA State Contractor License #:
State Zip Code
n Architect:
Phone: Fax:
Address:
City
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS: 3
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
JSP D..4°
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #:
❑ Check
0 Mastercard
Authorized Signature:
❑ VISA
❑ Other
Expires: VIN#: